Using Ultrapure Water in Hemodialysis Delays Carpal Tunnel Syndrome

Since 1977, our patients have undergone chronic HD with ultra-pure dialysate (UPD), defined as having endotoxin levels below 0.008 ng/ml and less than 1 bacteria/ml of dialysate. We evaluated the incidence of carpal tunnel syndrome (CTS) in three groups of patients. Group I (GI), 84 patients, dialysed for 6.1 ± 3.2 years (mean ± SD) with UPD only; Group II (GII), 39 patients, first dialysed for 3.7 ± 2.3 years with non-UPD and afterwards for 8.4 ± 2.1 years with UPD; Group III (G III), 103 patients treated for 6 ± 5.9 years exclusively with non-UPD. All patients were dialysed with cuprophan or cellulose acetate membranes.

Results, expressed by Kaplan-Meier actuarial survival curves as the percent of patients without CTS, show that CTS occurred significantly less in GI than in GIII. This may be due to less stimulation of monocytes resulting from the absence of bacteria, endotoxins and pyrogens in the dialysate which would reduce the stimulation of cytokines release, interleukin 1 and 6, and tumor necrosis factor, known to stimulate β2 microglobulin synthesis.

An experimental and clinical study of immunocompetence and immunostimulation in breast cancer

Two hundred and seven patients aged from 37 to 65 years with noninflammatory breast cancer treated by surgery without radiation were studied over a ten year period with a view to forecasting the prognosis on the basis of the immune status and treatment. The immunocompetence or immune status was studied in 121 patients by in vitro and in vivo pre and post-surgical skin tests. The immunostimulation or restoration of the immune status was conducted by the P 40 immunomodulator from the Pasteur Institute: in an experimental study whose results are based on modified Huggins model and take in to account the survival rate and the evaluation of tumor growth; in a subgroup of 86 patients, demonstrating that immunostimulation is effective in low-scores, improves tolerance to chemotherapy and increases the six year survival rate in high risk low-score patients. The results are encouraging enough to propose improving the survival rate in a prospective clinical study of early breast cancer treated by local and regional means using a protocol incorporating an immunostimulation based on the existing immunocompetence with interferon-induced reconversion of the target cells in the hope of specific stimulation.

[Silicone biliary prosthesis. 150 cases]

The silicone biliary prosthetic devices presented here are useful not only for biliary bypass but also for transtumoral intubations and to re-establish biliary tract continuity after certain types of excision. They are perfectly well tolerated. In this series of 150 cases, post-operative morbidity and mortality were low and the long-term results excellent. Good results were observed in 95% of patients with cancer of the hilum. Unlike percutaneous or endoscopic prosthetic devices these do not migrate or become obstructed. Survival exceeded 2 years in 60 patients with limited lesions.

Kron's biliary prosthetic bypass in the treatment of neoplastic jaundice

After experimental study in the dog, which showed the material to be highly reliable, an original method of biliary bypass using a silicone prosthesis in the treatment of neoplastic jaundice is introduced. This prosthesis allows the bile duct to be bypassed regardless of the location of the obstacle. This method was used in 150 patients; recession was sufficiently good in 84 of them to confirm good tolerance and the excellence of the results. In fact, good results were recorded in 95% of cases of cancer of the hilum, which is all the more remarkable in consideration of the difficulties involved in these operations. The main postoperative complications are bile fistulas which resolve spontaneously if the precaution of extensively draining the zones of intubation is taken; postoperative comfort is excellent; no constraint is necessary and the operative risk is moderate, this is particularly desirable in patients in a poor general condition. A short prosthesis makes transtumoral intubation possible, and a long prosthesis allows implantation in the digestive tract: stomach, duodenum or first intestinal loop. Postoperative persistence of jaundice is rare if a prosthesis of sufficient diameter is used and if no major bile duct or part of the liver is excluded. Cholangitis is exceptional and indicative of an excluded biliary area.

[Study of cellular immunity using Rebuck's skin-window (author's transl)]

Value of a modification of Rebuck's skin-window in cellular immunity studies. The mononuclear/polynuclear ratio is determined at given time-intervals. The increase in the number of macrophages as well as their kinetics can be pictured on a diagram, comparatively to the corresponding results in controls. This test appears to provide a means of assessing the activity of a malignant disorder.

[Heteromultinodular goitres. Clinical and therapeutic study (author's transl)]

Heteromultinodular goitres are frequent and the involutive forms require early surgical treatment for three reasons: these goitres are usually resistant to medical treatment; association with carcinoma is not uncommon (6.5% in this series); and the late surgery is hazardous, as it leads to extensive tissue resection and often entails a risk of recurrence and lesions of the parathyroid glands. Post-operative hormonal treatment should be reserved to those patients who have had wide tissue resection (replacement therapy for life, monitored by TSH assays) or to young patients who require a 2-year protective treatment. Prevention may perhaps be achieved by systematic 2-3 years' treatment of active homogenous hyperplasia in young subjects. Hyperplasia has a natural tendency to nodular involution, in most cases over several decades, but curiously, 30-35 years' old adults with large multinodular goitres are being operated upon as though these lesions had greater evolutive potential. This could be an argument in favour of post-operative protective therapy in these young patients.

Immunological investigation and immunotherapy in patients operated on for breast carcinoma

The tumor-host relationship is an essential factor in the onset, development, and recovery from malignancies. A basic consideration in the treatment of cancer patients must therefore be to understand this relationship and attempt to modify it in order to favor the host. We here discuss the results of a study of the immunologic status of 91 breast cancer patients. The use of a battery of tests with five subcutaneous hypersensitivity antigens allowed us to detect some differences in the immunological profiles of patients with or without lymph node involvement. The effect of an immunostimulant fraction prepared from Corynebacterium granulosum, P40 is also analyzed. This fraction significantly modifies tumoral recurrence in DMBA-induced mammary cancers in the Sprague Dawley rat, causes regression of mammary permeation nodules following in situ injection and modifies the cutaneous reactions of one-half of the anergic breast cancer patients although regular re-challenge is still necessary.

[Breast cancer: a dynamic approach of cellular immunity and immunostimulation with an immunoadjuvant: P40 fraction. (author's transl)]

The study of the immune status of breast cancer patients with delayed hypersensitivity skin tests reveals a clear immune deficiency in comparison with a reference patients group. This immunstatus was significantly improved by an immunstimulation with the P40 fraction. The responsive capacity to an immunstimulation appears independant of the lymphnodes involvment, whereas, on the contrary, the initial degree of immune deficiency appears connected. The P40 fraction has an immunstimulant effect comparable with the BCG and has not occasioned any local or general undesirable reaction.

[Thyroid carcinoma. Indications and results of treatment (author's transl)]

Frozen section histological study of all cold nodules requiring total extracapsular lobectomy is absolutely essential during surgery. Whilst total thyroidectomy for intracapsular carcinomas is most often proposed in extracapsular carcinomas, the authors deliberately leave a small part of the gland in contact with the parathyroids. The need for recurrent laryngeal lymph node dissection is accepted, as is the principle of jugulo-carotid dissection.

Benign breast disease and cancer

We report the necessity for thoroughly understanding the physiopathology of benign breast lesions in order to treat each type of lesion adequately. Three groups of women are outlined as a practical approach to this problem. Subadipose mastectomy is proposed to treat heteronodular mastopathy. This operation is compared with the subcutaneous mastectomy proposed by plastic surgeons.